title: Heart failure in patients with atrial fibrillation is associated with a high symptom and hospitalization burden: the RealiseAF survey.
abstract: BACKGROUND
  Atrial fibrillation (AF) and heart failure (HF) often coexist; the consequences of such coexistence are unclear.
  
  
  OBJECTIVE
  HF in patients with AF is associated with poor outcomes.
  
  
  METHODS
  This post hoc analysis of RealiseAF, a survey of AF patients, compared symptoms, hospitalizations, management, and AF control in patients with vs without HF. A total of 10,523 AF patients were analyzed according to presence/absence of HF.
  
  
  RESULTS
  History of HF was present in 45.8%, and in more patients with permanent vs persistent, paroxysmal, or first-episode AF (55.6%, 44.3%, 32.9%, and 29.8%, respectively; P < 0.0001). Patients with vs those without history of HF, and patients with HF and reduced ejection fraction (HF-REF) vs those with HF and a preserved ejection fraction (HF-PEF), had more frequent cardiovascular (CV) risk factors and more severe symptoms. Presence vs absence of HF, and HF-REF vs HF-PEF, were associated with lower rates of AF control (54.6% vs 62.8% and 49.3% vs 60.3%, respectively; both P < 0.0001). The rate-control strategy was used more frequently in HF patients, particularly those with HF-REF, than the rhythm-control strategy. CV hospitalizations occurred more frequently in patients with HF than those without (41.8% vs 17.5%; P < 0.001) and more frequently in patients with HF-REF than in those with HF-PEF (51.6% vs 35.6%; P < 0.0001).
  
  
  CONCLUSIONS
  AF patients with HF, particularly HF-REF, experience heavy symptom and hospitalization burdens, and have relatively low rates of AF control. Further studies are needed to identify ways to improve the management and treatment outcomes of this very high-risk patient population.
authors.affiliation: Department of Cardiology, Porto Medical School, São João Hospital, Porto, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Silva-Cardoso
authors.forename: Oleg J
authors.initials: OJ
authors.lastname: Zharinov
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Lisa
authors.initials: L
authors.lastname: Naditch-Brûlé
authors.forename: Thorsten
authors.initials: T
authors.lastname: Lewalter
authors.forename: Sandrine
authors.initials: S
authors.lastname: Brette
authors.forename: P Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D016277:Ventricular Function, Left